Provider Demographics
NPI:1154346740
Name:WICKIZER, CAREY LYNN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:CAREY
Middle Name:LYNN
Last Name:WICKIZER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:LYNN
Other - Last Name:WICKIZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:5837 IRONHORSE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-5296
Mailing Address - Country:US
Mailing Address - Phone:804-675-5000
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003004225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist